lung flare ups

Overview

A lung flare-up is a sudden worsening of your usual breathing symptoms, such as coughing, wheezing, or feeling short of breath. It is sometimes called an 'exacerbation.' Flare-ups often happen in people who already have a long-term lung condition, like asthma, COPD, or bronchiectasis. The goal is to get your symptoms back under control quickly and avoid a hospital stay.

Yes, lung flare-ups are common in people living with chronic lung conditions. Many people with COPD or asthma experience at least one flare-up per year, especially during cold and flu season.

Lung flare-ups mainly affect people who already have a lung condition. This includes people with asthma, COPD, bronchiectasis, or pulmonary fibrosis. Smokers, older adults, and people with weakened immune systems are also at higher risk.

Symptoms

Common symptoms

• Feeling more out of breath than usual when resting, walking, or talking
• A new or increased cough
• More mucus (phlegm) than usual, or mucus that is thicker, yellow, or green
• Wheezing (a whistling sound when you breathe)
• Tightness in the chest
• Feeling tired or weak
• Waking up at night due to breathing difficulties
• Needing to use your reliever inhaler more often than usual

Symptoms in children

• Fast or noisy breathing
• Flaring of the nostrils when breathing in
• Belly pulling in or out with each breath (in younger children)
• Feeding difficulties or poor appetite in babies
• Being less playful or unusually quiet
• Frequent coughing, especially at night

Symptoms in older adults

• Confusion or drowsiness (can be a sign of low oxygen)
• Difficulty talking in full sentences
• Faster heartbeat or feeling of a racing heart
• Swelling in the ankles or feet
• Less interest in eating or drinking
• Increased weakness or reduced mobility

Causes

Main causes

• Respiratory infections like the common cold, flu, or COVID-19
• Exposure to allergens such as pollen, dust mites, or pet dander
• Air pollution, smoke, or strong fumes
• Changes in weather, especially cold, damp air
• Stopping or missing your regular controller medicines
• Overexertion or physical stress

Risk factors

• Smoking or being exposed to secondhand smoke
• A history of frequent lung infections
• Poorly controlled asthma or COPD
• Older age
• Other health conditions like diabetes or heart disease
• Living in areas with high air pollution

When to see a doctor

See a doctor urgently if:

• If you have a lung condition and your symptoms do not improve within 24–48 hours of following your action plan
• If you are using your reliever inhaler more than every 4 hours
• If you are unable to complete your normal activities due to breathlessness
• If you feel your condition is getting worse despite taking your prescribed medicines

Book a routine appointment if:

• If you have had more than one flare-up in a year, talk to your doctor about adjusting your long-term treatment plan
• If you are not sure how to use your inhaler correctly
• If you need help to stop smoking or to manage other risk factors

Diagnosis

Your doctor will ask about your symptoms, listen to your chest, and may use a small device to measure how well you can breathe out. They will also ask about your medical history and any triggers you may have noticed.

Tests that may be done

• Spirometry: a breathing test that measures how much air you can blow out quickly
• Peak flow test: a handheld device that measures your best airflow (especially used in asthma)
• Pulse oximetry: a painless clip on your finger that checks oxygen levels in your blood
• Chest X-ray: may be done if the doctor suspects pneumonia or another chest problem
• Blood tests or a mucus sample: may be used to look for signs of infection

What to expect at your appointment

Your doctor will use your symptoms, history, and test results to confirm whether you are having a flare-up and how severe it is. They will often give you a written 'action plan' that tells you exactly what to do when symptoms worsen. You should also be offered advice on preventing future flare-ups.

Treatment

Treatment for a lung flare-up focuses on opening your airways, reducing inflammation, and treating any infection. Your plan will depend on how severe the flare-up is and the underlying lung condition. Always follow the instructions from your healthcare provider.

Self-care at home

• Take your reliever inhaler as prescribed, often just a few puffs when symptoms start
• Use a spacer device with your inhaler if you have one, as it helps more medicine reach your lungs
• Rest and stay in a comfortable, well-ventilated room
• Drink small sips of water frequently to stay hydrated and thin mucus
• Avoid smoke, dust, and other triggers
• Do breathing exercises like 'pursed-lip breathing' (breathe in slowly through your nose, then purse your lips and breathe out gently)
• Check your temperature and watch for signs of infection, such as a fever or coloured mucus

Medical treatments

Your doctor may prescribe medicines to help open your airways (bronchodilators), reduce inflammation (corticosteroids), or treat a bacterial infection (antibiotics). These are usually inhaled, but some may be given as tablets or through a nebuliser. If your oxygen level is low, you may receive oxygen therapy. The choice of medicine depends on your individual condition and the likely cause of the flare-up.

When is surgery considered?

Surgery is rarely needed for a lung flare-up itself. However, if you have severe lung disease that keeps causing flare-ups, your specialist may discuss other procedures, such as treatments to reduce lung volume or a lung transplant, but this is only considered in very specific cases.

Living with this condition

Living with a lung condition means learning to manage your symptoms every day. Keep your medicines close by, follow your action plan, and know the early signs of a flare-up. Plan your activities so you do not overexert yourself, and save energy for what matters most.

Lifestyle tips

• Quit smoking and avoid secondhand smoke
• Get the flu vaccine every year and ask about the pneumonia vaccine
• Wash your hands often to reduce the risk of infections
• Avoid crowded places during cold and flu season
• Keep your home clean and dust-free, and consider using an air purifier if pollution is a problem
• Learn and practise breathing exercises to help you stay calm during flare-ups

Diet and exercise

Eating a balanced diet with plenty of fruits, vegetables, and lean protein can help maintain your strength and immune system. If you are overweight, losing weight can reduce the load on your chest. Gentle exercise, such as walking or pulmonary rehabilitation, can improve your fitness and reduce the frequency of flare-ups. Always check with your healthcare team before starting a new exercise program.

Mental health and emotional wellbeing

Lung flare-ups can be frightening and stressful. Anxiety and breathlessness can feed off each other, making symptoms feel worse. It is important to recognise when you feel overwhelmed and to ask for support. Deep breathing, relaxation techniques, and talking to someone you trust can help. If you feel anxious or depressed, speak to your doctor about getting appropriate support.

Prevention

You can reduce the chance of a lung flare-up by taking your prescribed medicines regularly, avoiding triggers, and getting vaccinated against respiratory infections. A written action plan can help you act early and prevent a mild flare-up from turning into a serious one.

Vaccines

Vaccines play a key role in prevention. Ask your healthcare provider about the yearly flu vaccine, the COVID-19 vaccine, and the pneumococcal vaccine. These vaccines help protect you from infections that commonly trigger flare-ups.

Screening programmes

There is no routine screening for lung flare-ups. However, if you have a chronic lung condition, regular check-ups with your doctor are important to adjust your treatment and catch problems early.

Complications

If left untreated

• Worsening breathlessness that can lead to respiratory failure
• Low oxygen levels in the blood (hypoxemia), which can affect the heart and brain
• The need for hospitalisation and oxygen therapy
• Weakening of the respiratory muscles over time
• Increased risk of heart problems, especially in older adults
• A reduced quality of life if flare-ups become frequent

Long-term outlook

The outlook for most people with lung flare-ups is good, especially when they are treated early and patients have a clear action plan. With proper management, many people continue to live full, active lives. Flare-ups can be a sign that your long-term treatment needs adjustment, so use them as a prompt to work with your doctor to improve your overall lung health.

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